Health care reform — unconstitutional or not?

Two judges have ruled the massive new health care law unconstitutional.  Two other judges have ruled that the law is constitutional.  What does this mean?

Dr. Mark Hall, Professor of both Law and Social Sciences & Health Policy at Wake Forest University explains the implications of these rulings, their underlying basis in constitutional law and what happens next in a wonderful article in the New England Journal of Medicine.

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Whether it’s TSA or medicine, transparency is a good thing

NPR reports that Congressman John Mica has been pushing to replace TSA airport screening employees with screeners from private companies, and that those companies have been major contributors to Congressman Mica.  Maybe replacing TSA employees with private screeners is a good idea, maybe it isn’t.  But do we trust the opinion of a Congressman who is taking money from the companies that would benefit from this policy?  Doesn’t that money make us question his judgment on this issue?

The reason I ask has nothing to do with airport screening.  The doubt that I feel when I hear this Congressman pushing policies that help the people who give him money makes we wonder if this is how some patients feel about the advice they get from their doctor — knowing the doctor received money for services provided to drug companies.

There are growing regulations at many levels on the relationship between health care providers and drug companies.  There is also greater transparency as drug companies start reporting what they give doctors. Transparency is a good thing.

It’s too bad that when it comes to politicians, it seems we are moving in the other direction — more money and less transparency.

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Patients Want to Know What Doctors Think about Reform

Many people are debating health care reform in the United States. I find that my patients don’t debate me about it. Instead, they just want my opinion. They want to know what doctors think. It’s great to have one’s opinion held in such high esteem. Doctors should be playing a critical role in the debate.

Hopefully doctors’ concerns will go beyond concern about Medicare reimbursement cutbacks and medical malpractice reform. While those issues may be important, they aren’t the only issues and may not even be the most important ones. Increasing and ensuring access, controlling costs, and avoiding excessive rationing are the biggest considerations, at least in my opinion.

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Accountability

Physicians are very concerned about an impending 21 percent Medicare pay cut (now due to occur in October) and the “broken” formula that causes it. When any other group asks for legislative largess, physicians are right to ask, “Where will the money come from to pay for this?”

Not long ago one of my Senators sent a message to constituents talking about how he had helped arrange for greater veteran health benefits. Greater veteran health benefits are wonderful, but the Senator didn’t say where the money was coming from. Was it from cuts in another program, was it from new taxes, or was it from increasing our national debt?

As physicians, we should take some leadership. If we want the government to end the plan for the scheduled cut and “fix the broken formula,” we ought to hold ourselves accountable to say where the money should come from. Are we asking for more Medicare taxes to pay for this?

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